Abstract 136: Family Member Perceptions of Decision-Making for Comatose Survivors of Cardiac Arrest

Abstract

Introduction: Out-of-hospital cardiac arrest (OHCA) is an unexpected event that can render patients incapable of decision-making, requiring a surrogate decision maker (SDM), most often a family member, to be engaged. Yet how SDMs understand the information provided, and how they view their experience of making decisions for cardiac arrest patients is not well understood. Methods: This inductive qualitative study utilized data from semi-structured open-ended interviews with SDMs for OHCA patients. SDMs were approached: 1) at the bedside for consent to contact; and 2) 30 days after discharge/death to consent to interview. Interviews were conducted using a semi-structured interview guide, recorded, and transcribed for analysis. Transcripts were read in entirety and thematically coded by two investigators. Results: Over a 5-month period (1/18-5/18), 7 SDMs consented; however, 11 individuals were interviewed, as 3 SDMs invited family members to join the interviews. SDMs were living spouses (2), adult children (2), a parent (1) and siblings (2). Within this sample, 71.4% (5/7) of SDMs decided to withdraw life sustaining therapy or discontinue resuscitative efforts for their family member. Overall, experiences varied dramatically, with some families reporting a positive experience and others clearly reporting concerns about how the decision making process occurred. Major themes identified that affected the experience of decision-making include how SDMs perceived provider communication style, how they processed medical uncertainty from the providers, confidence in their decisions, and finally, conflict/discordance between the medical team and family. Families identified the following factors that might improve the decision making process for future SDMs; 1) updated “goals for the day”; 2) access to medical records; 3) Access to protocols for post-arrest patients; 4) a consistent liaison to the medical team; 5) consistent messaging amongst the care team. Conclusions: In this sample of SDMs, experiences with decision-making were variable. Notably, communication factors predominated in SDMs experience with decision-making. Finally, multiple important factors were identified to assist future SDMs in decision making for post-OHCA patients.